2023 Author: Josephine Shorter | [email protected]. Last modified: 2023-11-27 04:34
Causes and symptoms of otitis media, how to treat it?
- What is otitis media?
- Otitis symptoms
- Otitis media
- Complications and consequences
- Diagnosis of otitis media
- What to do with otitis media?
- How is otitis media treated?
- Otitis prevention
What is otitis media?
Otitis media is an inflammation of the ear. The disease can be chronic or acute, purulent or catarrhal. The severity of the pathological process depends entirely on the virulence of microorganisms, and the state of human immune defense plays an important role.
Statistics say that 30% of all otolaryngological diseases are acute otitis media. Preschool children get sick much more often than adults. By the age of three, 80% of children suffer from otitis media.
The organ of hearing can be affected, causing otitis media:
- Hemophilic sticks and other microorganisms.
Any ear inflammation is extremely dangerous, and you should see a doctor immediately after detecting the symptoms of the disease described below.
Symptoms of otitis media, by which you can recognize acute otitis media, are the following signs: severe pain in the ear (according to patients it is described as shooting), fever, and after 1-3 days - purulent discharge from the ear canal. After the appearance of pus, the patient's condition usually improves, the temperature decreases, the pain becomes less pronounced or disappears altogether.
Pus is released from a breakthrough through the eardrum. Such an outcome of the disease is considered positive; with proper treatment, the hole in the eardrum gradually overgrows, without affecting hearing.
With an unfavorable development of the disease, pus cannot find a way out, and this is fraught with the fact that the infection can begin to spread inside the skull. Such otitis media can turn into meningitis, as well as into a brain abscess. In order to avoid such dire consequences, at the first symptoms of otitis media, contact an otolaryngologist for advice and proper treatment.
Otitis media, depending on the localization of inflammation, can be:
Otitis externa often affects swimmers, therefore, the disease is popularly called "swimmer's ear". The inflammation begins due to mechanical trauma to the auricle or external auditory canal. Damage to the protective cover leads to the ingress and multiplication of pathogenic microorganisms, then a furuncle forms at this place.
If not immediately treated, otitis externa becomes severe and spreads to the parotid cartilage and bones. With this type of disease, the patient is worried about aching, throbbing pain, swelling of the ear and a moderate increase in temperature.
With otitis media, the inflammatory process spreads to the airways of the middle ear, located immediately behind the tympanic membrane: the tympanic cavity, the auditory tube and the mastoid process.
The form of otitis media often flows from catarrhal to purulent.
Acute catarrhal otitis media of the middle ear occurs as a complication of acute respiratory infections or acute respiratory viral infections, after the penetration of the causative agent into the tympanic cavity. At the initial stage, hearing level may decrease, tinnitus may appear, but the temperature remains normal or slightly rises.
If these symptoms are ignored, then catarrhal otitis media is manifested by a sharp and strong increase in temperature and shooting pain in the ear, spreading to the eye, neck, pharynx or teeth. You can cure such otitis media only by getting rid of the infection, for which you need to urgently consult a doctor.
Acute purulent otitis media of the middle ear is a neglected catarrhal form. The disease is manifested by a breakthrough of the tympanic membrane and the leakage of pus, followed by a decrease in body temperature. Treatment, in addition to fighting the infection, should include permanent removal of the pus from the ear, which only a healthcare professional can do.
In addition, pus may not always come out on its own. If the eardrum is very strong, an eardrum puncture surgery is needed. This procedure is called "paracentesis" and is carried out using a local anesthetic: a puncture is made with a special instrument at the most favorable point, and the pus is completely released.
After the pus is removed, the eardrum is scarred and the quality of hearing is not further reduced.
If acute otitis media is left untreated, pus will spread inside the skull. As a result, internal otitis media develops, affecting the vestibular apparatus, causing an abscess in the brain and leading, at least, to partial or complete hearing loss. Therefore, at the first signs of otitis media, you should not try to drip something into your ears, or lay a tampon with alcohol or other antiseptic, but you need to go to the doctor urgently!
Each ENT disease is accompanied by an increased production of mucus. As its amount increases, with an unfortunate coincidence of circumstances, mucus enters the Eustachian tube, disrupting the ventilation of the tympanic cavity. The cells of the tympanic cavity secrete an inflammatory fluid. In addition to blocking the lumen of the Eustachian tube, pathogenic microorganisms, which are normally part of the local microflora, also contribute to the aggravation of inflammation.
The causes of otitis media are:
- Penetration of infection from other ENT organs - as a complication of a concomitant infectious-viral disease;
- Various diseases of the nose, sinuses and nasopharynx. This includes all types of rhinitis, curvature of the nasal septum, and in children - adenoids (adenoid vegetation);
- Ear trauma;
- Hypothermia and weakened immunity.
Complications and consequences of otitis media
Although only the ears hurt with otitis media, complications with inadequate treatment or lack of it can affect many organs. Incomplete treatment of otitis media leads to very terrible consequences - suppuration passes to the lower jaw, touching the salivary gland and often leading to disability.
But what makes otitis media even more dangerous is that this disease is not always easy to detect. For example, in some cases, the disease is not accompanied by acute pain in the ears. Often, due to otitis media, the work of the gastrointestinal tract is disrupted. This is because our abdominal region and ear are connected by the same nerve. Therefore, during otitis media, especially in a child, the intestines may swell, vomiting, and constipation may appear. That is, you can suspect appendicitis, in which case you will be referred to a surgeon. But the diagnosis of inflammatory diseases in young children must be carried out with the participation of an ENT doctor.
If a mother thinks that her child has just an upset of the gastrointestinal tract, and takes up independent treatment, in the meantime, otitis media can develop into a more serious disease - otoanthritis. This is a situation in which pus passes into the behind-the-ear region and another inflammation joins, as a result of which the ears bulge outwardly, edema appears and the temperature rises again. A complication can occur both in the coming days and in a month, that is, it cannot be predicted. If these symptoms of otitis media are not noticed, then meningitis will develop in a couple of months, so be careful with otitis media.
Other common complications of otitis media include the transition to the chronic stage, damage to the vestibular apparatus and hearing loss.
In addition, a complication of otitis media can be:
Meningitis and other intracranial complications (brain abscess, encephalitis, hydrocephalus) - the stage following otoantritis, if measures are not taken in time;
- Paresis of the facial nerve;
- Rupture of the tympanic membrane and filling of the ear cavity with pus;
- Cholesteatoma - overlapping of the auditory canal with a tumor-like cystic formation in the form of a capsule with dead epithelium and keratin;
- Mastoiditis - inflammation of the mastoid process, causing destruction of the auditory ossicles in the middle ear;
- Disorder of the gastrointestinal tract - bloating, vomiting, diarrhea;
- Persistent hearing impairment, hearing loss (up to complete deafness).
Chronic otitis media is extremely difficult to treat and greatly reduces the quality of life - hearing is impaired, there is a constant inflammatory process in the ears and suppuration occurs. Often, to get rid of chronic otitis media in adults, conservative treatment is not enough, and you have to resort to surgery.
Diagnosis of otitis media
A competent doctor diagnoses acute otitis media without special devices and innovative technologies. A simple examination of the auricle and auditory canal with a head reflector (mirror with a hole in the center) or an otoscope is enough to diagnose otitis media.
How is otitis externa diagnosed?
With otitis externa, the doctor pays attention to the skin in the area of the auricle, the size of the ear canal and discharge from it. If the auditory lumen is severely narrowed, especially if the eardrum is not even visible, the skin turns red and there is liquid discharge inside the ear, this allows the doctor to diagnose otitis externa.
How is otitis media diagnosed?
Acute otitis media is also diagnosed to a greater extent by external examination. The doctor is guided by some of the characteristic signs of this disease: a reddened eardrum, limitation of its mobility and the presence of perforation.
All these symptoms are easy to check - it is enough for the patient to puff out his cheeks without opening his mouth. Ear blowing, a technique called the Valsalva maneuver, is routinely used by divers and divers to equalize the pressure in the ear during deep descent. As air enters the tympanic cavity, the membrane bends noticeably, and if the cavity is overflowing with fluid, then there will be no bending.
Perforation in the tympanic membrane with otitis media is noticeable to the naked eye after the ear cavity is filled with pus and it flows out with a breakthrough.
Clarification of the diagnosis of internal otitis media: audiometry
Hearing examination on a special apparatus - audiometry, as well as measuring the pressure inside the ear - tympanometry - is used to clarify the diagnosis if chronic otitis media is suspected.
If hearing acuity with ongoing otitis media drops sharply, and attacks of dizziness begin, there is a reasonable suspicion of otitis media (inflammation of the ear labyrinth). In this case, audiometry is used, they resort to the help of an otolaryngologist and a neurological examination.
X-ray and computed tomography
Radiography for acute otitis media is used to confirm its complications - severe intracranial infections or mastoiditis. These are quite rare cases, but if these dangerous complications are suspected, CT of the brain and temporal bones of the skull is necessary.
Determination of bacterial flora in otitis media
Bacterial culture for otitis media, at first glance, seems like a pointless study. Indeed, it takes time for the cultivation of bacteria, and the result of the analysis will be visible only for 6-7 days, and if timely treatment of otitis media is carried out, the disease should already have passed by this time. But not in all cases of otitis media, the usual antibiotics help, and if the doctor knows from the results of the smear which microorganisms caused the otitis media, he will prescribe a known suitable drug.
What to do with otitis media?
As soon as there are uncomfortable sensations in the ears, whether it be periodic congestion or aching pains, you should immediately consult a doctor for competent treatment. Otherwise, acute otitis media is likely to turn into chronic, leaving behind scars, thinning, retraction or a gap on the eardrum, after which the patient will experience frequent inflammation and hearing loss.
If it is impossible to see a doctor on the same day when the pains appeared, then the only thing that can be done is to use antihistamines internally (by reducing the pressure in the ear, the pain subsides), and in case of severe pain, pain relievers.
Attention: camphor oil, chamomile infusion, boric alcohol, onion and garlic juice or herbal suppositories - any of these "healing" drugs for the treatment of otitis media can lead to deafness for life. The same goes for warming with sand, salt or a heating pad. The inflammatory process in the ear will intensify several times, because these folk remedies give bacteria food and accelerate their reproduction, provoking the accumulation of pus and severe swelling. Alcohol-based antiseptics are especially dangerous for children with delicate, sensitive mucous membranes.
But the worst thing is the ingress of pus into the brain, leading to irreversible consequences - a person can remain disabled forever!
How is otitis media treated?
Regardless of the form of otitis media, the patient needs pain medications, as it is unbearable to endure ear pain. Usually these are non-steroidal anti-inflammatory drugs, the most commonly prescribed today is ibuprofen. While taking NSAIDs, the patient should be under constant medical supervision.
How is otitis externa treated?
If otitis externa is found in adults, the main treatment will be with ear drops. In a healthy person with normal immunity, otitis externa will disappear with the use of only drops, antibiotics in injections or tablets will not be needed. Drops can only consist of an antibacterial drug, or they can combine an antibiotic and an anti-inflammatory agent. Otitis externa is treated with drops on average for a week.
Basically, for the treatment of otitis externa are prescribed:
- Antibiotics - norfloxacin (Normax), ciprofloxacin hydrochloride (Ciprolet), rifamycin (Otofa);
- Antibiotics with corticosteroids - Candibiotic (beclomethasone, lidocaine, clotrimazole, chloramphenicol), Sofradex (dexamethasone, framycetin, gramicidin);
- Antiseptics (Miramistin);
- Antifungal ointments - clotrimazole (Candide), natamycin (Pimafucin, Pimafukort) - are prescribed if otitis externa is of fungal origin.
Of the recently proven remedies, an ointment with the active ingredient "mupirocin" is used, which does not have a pathological effect on the normal microflora of the skin, but is active against fungi.
How are acute otitis media and auditory labyrinth treated in adults?
It is customary to treat otitis media with antibacterial drugs. But the treatment of otitis media in adults is slightly different from the treatment of childhood diseases - the frequency of spontaneous recovery from otitis media in an adult is more than 90 percent, which practically negates the need for antibiotics. But the remaining 10 percent have very serious consequences, so if after the first two days of the disease there is no improvement, then antibiotics are prescribed.
Antibiotics should be prescribed by a qualified doctor, as this class of drugs is extremely dangerous due to side effects. However, mortality from complications of otitis media reaches 28,000 people a year, so, as a rule, treatment is justified. Usually antibiotics are given in pill form, but if the patient cannot take the pill, injections are used.
To treat otitis media in adults, use:
- Amoxicillin (Flemoxin Solutab, Ecobol, Ospamox or Amosin);
- The combination of amoxicillin with clavunalic acid (Flemoklav, Augmentin, Ekoklav);
- Cefuroxime (Cefurus, Aksetin, Zinnat, Zinacef).
It is possible to prescribe other drugs, but it is important to comply with the basic requirement of antibiotic therapy: to complete a course of treatment that lasts at least a week. If the microorganisms do not become extinct due to the interruption of antibiotic use, the bacteria develop resistance to this group of drugs, and the antibiotics stop working.
Ear drops for otitis media
Comprehensive treatment for otitis media of the middle ear often includes the use of drops. It is extremely important to know that not all ear drops are the same, and if your ear hurts, then not all drops will work. The difference is that before the tympanic membrane is damaged and after its perforation, the active substance for the treatment of otitis media is completely different.
If the eardrum is intact, then use anesthetic drops - Otipax, Otinum or Otisol - with lidocaine, benzocaine or choline salicylate. In the catarrhal form of otitis media in adults, drops with an antibiotic will not help at all, since the substance does not enter the source of inflammation - behind the eardrum.
When pus has burst out and the tympanic cavity is open, on the contrary, drops with an analgesic effect are contraindicated, since they can lead to undesirable consequences. Moreover, with the flow of pus, the pain subsides.
In order to prevent repeated suppuration or the ingress of pus into the inner ear, antibiotics are prescribed to drip into the open tympanic cavity - these are Normax, Ciprofarm, Miramistin and others, only a doctor should prescribe them. The use of ototoxic antibiotics, drugs for alcohol, with phenazone or choline salicylate is strictly prohibited.
On the subject: Antibiotics and drops in the ears for otitis media
Paracentesis of the tympanic membrane - an extreme measure
When the therapeutic treatment of otitis media with medication does not work, a large amount of pus accumulates behind the eardrum. This leads to very severe pain and increased absorption of bacteria waste into the blood. General intoxication of the body occurs. As soon as such symptoms appear, doctors urgently prescribe paracentesis - an operation that prevents severe complications of otitis media.
The operation is performed under local anesthesia. In the process of paracentesis, the eardrum is incised with a special needle in the thinnest place in order to minimize injury to the tissue, and pus flows out through the resulting hole. Moreover, a neatly incised wound heals much faster than a hole with natural perforation, and after paracentesis, a minimal scar is formed.
The next day, a sharp improvement in well-being occurs and the patient's recovery is accelerated. This is especially true for paracentesis in the treatment of otitis media in children.
Emergency paracentesis is indicated for:
- Inflammation of the inner ear;
- The defeat of the meninges, manifested in the form of headache and nausea;
- Damage to the facial nerve;
- If within three days after the start of antibiotic therapy, the pain does not subside and the suppuration does not subside.
Unlike otitis externa or otitis media of varying severity, inflammation of the auditory labyrinth is treated comprehensively, and only in a medical facility under the constant supervision of a neurologist and otolaryngologist. To treat the labyrinth, not only antibiotics are required, but also neuroprotective agents and drugs to improve blood microcirculation in the inner ear.
[Video] Dr. Berg - Best NATURAL Otitis Remedy:
On the subject: Treatment of otitis media at home
The main goal of preventing otitis media in adults is to prevent the Eustachian tube from becoming blocked by thick mucus. This is not an easy task. As a rule, acute rhinitis is accompanied by liquid discharge, but during treatment, the mucus often becomes much thicker, stagnating in the nasopharynx.
In order to prevent the development of otitis media caused by stagnant purulent processes, it is necessary to promptly treat the corresponding ENT diseases - a banal rhinitis, sinusitis, or remove adenoids from the pharynx.
What to do to prevent complications of ENT diseases in the form of otitis media:
- Use vasoconstrictor drugs in the nose to reduce mucosal edema;
- Maintain fluid balance in the body, drink more water;
- Timely take antipyretic drugs at a very high temperature, preventing its retention;
- Maintain the air temperature in the living room within the range of 18 to 20 ° C Celsius;
- Maintain humidity in the room, ventilate and regularly do wet cleaning;
- Observe the measure in blowing your nose - in no case overdo it, as this causes blockage of the auditory tubes and stagnation of infected mucus, and blow out each nostril, pinching them separately.
But the most important prevention at the very first symptoms will be a timely visit to a doctor. He will examine the eardrum and determine in which part of the ear otitis media, whether purulent exudate has collected in the tympanic cavity. You may need a blood test, or another examination, according to the results of which the doctor will select the correct treatment and save the patient from the terrible complications of otitis media.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)
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